| The effect of hiatus hernia on gastro-oesophageal junction pressure. | |
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MedLine Citation:
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PMID: 10075953 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hiatus hernia and lower oesophageal sphincter hypotension are often viewed as opposing hypotheses for gastro-oesophageal junction incompetence. AIMS: To examine the interaction between hiatus hernia and lower oesophageal sphincter hypotension. METHODS: In seven normal subjects and seven patients with hiatus hernia, the squamocolumnar junction and intragastric margin of the gastro-oesophageal junction were marked with endoscopically placed clips. Axial and radial characteristics of the gastro-oesophageal junction high pressure zone were mapped relative to the hiatus and clips during concurrent fluoroscopy and manometry. Responses to inspiration and abdominal compression were also analysed. RESULTS: In normal individuals the squamocolumnar junction was 0.5 cm below the hiatus and the gastro-oesophageal junction high pressure zone extended 1.1 cm distal to that. In those with hiatus hernia, the gastro-oesophageal junction high pressure zone had two discrete segments, one proximal to the squamocolumnar junction and one distal, attributable to the extrinsic compression within the hiatal canal. Inspiration and abdominal compression mainly augmented the distal one. Simulation of hernia reduction by algebraically summing the proximal segment pressures with the hiatal canal pressures restored normal maximal pressure, radial asymmetry, and dynamic responses of the gastro-oesophageal junction. CONCLUSIONS: Hiatus hernia reduces lower oesophageal sphincter pressure and alters its dynamic responsiveness by spatially separating pressure components derived from the intrinsic lower oesophageal sphincter and the extrinsic compression of the oesophagus within the hiatal canal. |
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Authors:
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P J Kahrilas; S Lin; J Chen; M Manka |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Gut Volume: 44 ISSN: 0017-5749 ISO Abbreviation: Gut Publication Date: 1999 Apr |
Date Detail:
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Created Date: 1999-06-10 Completed Date: 1999-06-10 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 2985108R Medline TA: Gut Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 476-82 Citation Subset: AIM; IM |
Affiliation:
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Northwestern University Medical School, Division of Gastroenterology and Hepatology, Department of Medicine, Passavant Pavilion, Suite 746, 303 East Superior St, Chicago, Illinois 60611-3053, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Esophagogastric Junction / physiopathology* Female Fluoroscopy Gastroesophageal Reflux / etiology Hernia, Hiatal / complications, physiopathology* Humans Inhalation / physiology Male Manometry Middle Aged Pressure |
| Grant Support | |
ID/Acronym/Agency:
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R01 DC00646/DC/NIDCD NIH HHS |
| Comments/Corrections | |
Comment In:
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Gut. 2000 May;46(5):740
[PMID:
10836855
]
Gut. 1999 Apr;44(4):449-50 [PMID: 10075944 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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